NURSING 1 Essay Example

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According to Bravo et al, (2016, Pg. 70), standard 4 medication safety provides for competent clinicians safely prescribing, dispensing and administering appropriate medicines to patients. It is against these parameters that most of the standard 4 medication safety objectives are established. Essentially, most of these objectives revolve around the welfare and safety of the patients and the members of the public. For instance one objective that the Standard 4 medication safety highlights is, to ensure that competent clinicians prescribe medication correctly and have proceedings recorded in case of a handover or a change in shifts. Nurse X therefore violated the provisions of standard 4 medication safety stipulations when she administered intravenous fluid with dextrose saline instead of normal saline.

The nurse violated various other provisions of the standard 4 medication safety including its provision for potential extra expense imposition on the patient. Consequence of the possible effects that the dextrose saline
could cause could be fatal or at least costly to rectify if not fatal.

Governance Framework

As shown by Rajasekaran et al, (2017, Pg. 39), standard 4 medication safety provides that a governance rationale be put into place to ensure that matters pertaining to healthcare provision are handled accordingly. Essentially the various stipulations on healthcare best practice must be followed to the letter as the standard provides. For example there should be the establishment of elaborate medication management systems. History of the patients must be recorded and medical progress for the inpatients precisely recorded. This would have possibly avoided the incident of nurse X administering the wrong intravenous fluid.

Medical Safety Committee

In large healthcare organizations the standard 4 medication safety provides that a committee be established. The roles of such committee vary with the nature of the organization but essentially the functions of these committees as the standard 4 medication safety outlines involves appropriate medical prescriptions and administration. Farre et al, (2017, Pg. 71) suggests that these committees can come up with the above named governance frameworks. An example of such a committee is the Advisory Committee on Medical Devices, ACMD.

Diagnostic Treatment Centre, (DTC) Review

The terms of reference of the DTC should be reviewed as the standard 4 medication safety provides. This will essentially ensure that functions that relate to medication management and safety are defined as illustrated by Farre et al, (2017, Pg. 60). For example this will help in the development of prescription guidelines.

Governance Group Review

According to Wahr et al, (2016, Pg. 88), the composition of the groups, the roles of the various governance officers, their responsibilities and accountabilities should be reviewed and reshaped if need arises especially if such officers are responsible with medication management.

Establishing Positions

In large healthcare institutions especially those that have potential for growth, more health officers might be required as shown by Bravo et al, (2016, Pg. 44). The fact that Nurse X went for a meal break without briefing the handover nurse on patient B progress is a likely indication of understaffing or rough handover protocols. An organization should consider coming up with the position for a handover officer for example. The role of such officer would thus be to ensure that handovers proceed in a smooth fashion and that any communications are timely conveyed to the nurse taking over a particular patient.

Organizational Culture

According to Gillespie & Reader, (2017, Pg. 10), ideas relating to organizational culture have been around for over a decade. For a long time many people have always perceived organizational culture as being very critical in as far as organizational performance in concerned and this irrespective of the type or nature of the organization. Aspects of cultural diversity and the competition this generates are for example some vital cultural elements that an organization needs polish in order to achieve results.

Laforet, (2017, Pg. 70) says that, “the culture of medical autonomy even in groups that have conflicting interests like managers and clinicians is still evident in today organizational set ups.” The idea of organizational culture supersedes the simple principals of belief, attitude, values, norms and behavior that have long been used to generate perceptions on organizational culture and the associated means of ensuring that the culture an organization adopts is positive and well with the organizations long term objectives

Types of Organizational Culture

a. Integrated Organizational Culture

People usually have varied cultural perceptions regarding the simplest aspects of life. This they can carry with them to their various working stations. The cultural ideas may be different but it’s possible to arrive into consensus on basic beliefs for instance the idea that hard work pays as suggested by Giles & Bills, (2017, Pg. 33). This type of culture thus means that various culture merge to execute common or share grounds.

b. Differentiated Organizational Culture

As opposed to integrated culture, here the cultural perceptions of members of the organization differ greatly such that it’s impossible to work as a unit. In deed organizations that promote this type of culture have different departments that run independent of others. A good example would be the government and its various arms.

3. Fragmented Organizational Culture

With this culture it is not clear as to which type of culture the organization has decided to adopt. There are both aspects of integrated and differentiated culture. According to McSherry & Pearce, (2017, Pg. 21), members of such an organization are often at a liberty to adopt the type of culture that works best for them.

Aspects of Organizational Culture

a. Attitude to Innovation and Risk Taking

This basically denotes the organizations ability to either adopt new ideas or change as they occur in the contemporary world or stick to a preservative nature of maintaining old ideals and practices as suggested by Laforet, (2017, Pg. 44). For example healthcare institutions may or not adopt the use of micro chips on patients for registration.

b. Degree of Central Direction

This basically speaks of the objectivity of the organization. The organizations employees may for instance be channeling their efforts towards the realization of a common goal which actually is the ideal approach for many organizations.

c. Pattern of Communication

Novak et al, (2017, Pg. 66), says that “every organization has its own way of conveying information that it has established over time to an extent that it has become an integral part of its culture.” The two widely used models here for example are formal and informal communication mechanisms

d. Process Orientation

This refers to the control and reward mechanisms that an organization have abided to over time. Organizations can thus choose to be control and reward oriented or is end product oriented.

e. Team Orientations

In a much as most organizations opt to have a sort of teamwork philosophy, it is worth noting that some organizations tolerate individual brilliance and they go as far as partaking performance appraisal initiatives with the sole aim of further encouraging individual efforts as illustrated by McSherry & Pearce, (2017, Pg. 12).

Factors That Promote Positive Organizational Culture

a. Legacy Definition

Gills & Bills, (2017, Pg. 45) says that, “In order to attain positive organizational culture, the organization must have precise objectives and goals along which the required culture must align.” It should be clear for instance for employees to know what the organization expects from them.

b. Hiring Smartly

The employees an organization has will go a long way in establishing the nature of the organizations culture as suggested by Gillespie & Reader, (2017, Pg. 87). The personnel department must have a clear sight of the types of employees they need, ones who can advance the culture of the organization positively. For example a hospital whose main objective is punctuality should not employ a doctor who always arrives to work late.

c. Listening

Culture is favorable to an organization especially if it can bend when need arises. According to Novak et al, (2017, Pg. 75), the organizational leadership should as such be keen to protect the cultural context of the organization including changing when the trend demands that there be a change.

d. Engagement

A successful organizational culture should be one that involves all the necessary stakeholders external and internal alike as shown by Fossum et al, (2016, Pg. 69). Views and perceptions of each member of the organization especially those that relate to the organizations culture must be listened to and accessed for implementation possibility as shown by Laforet, (2017, Pg. 33) .

a. Mandatory reporting

According to Bismark et al, (2016, Pg. 70), those involved with health of the people have not only professional obligation but also ethical responsibility of ensuring public health and safe health care is promoted. Nurse X for instance just like all the other nurses in the healthcare facility had a responsibility of ensuring that an error like there being a mix up in intravenous solution administration does not occur to the patient B as such greatly put the patient at risk.

Dextrose saline instead of normal saline for instance could have led to vein irritation, swelling and high blood sugar had intervention not have been timely. Therefore mandatory reporting is the medical aspect that requires such a case to be reported to the relevant authorities as it is clear that there has been a malpractice in the healthcare administration as shown by Mathews et al, (2016, Pg. 90).

b. Notifiable Conduct

Brashler et al, (2016, Pg. 66) suggests that standard 4 medication safety has four provisions on notifiable conduct. It defines this as either one of the following;

  • Risking members of the public because of departure from professional standards that are acceptable.

  • Attempting to practice while under alcoholic intoxication.

  • Exhibiting characters that may add up to sexual misconduct while in the profession.

  • Having the public placed at risk due to reasons that may amount to impairment.

In the case scenario provided the most suitable definition is risking members of the public due to departure from what may be considered as acceptable professional standards as suggested by Greenfield et al, (2016, Pg. 65). Nurse X is thus liable since she risked the general well being of the patient B. As has already been discussed, prolonged exposure to the wrong intravenous fluid dextrose saline instead of normal saline could have had adverse effects as already shown not to mention extra cost for additional care in the worst case scenario loss of life

c. Reasonable Belief

According to the legislative requirements for Australian healthcare practitioners this basically means that one has some suspicion that a health practitioner has acted contrary to the well laid out standards of healthcare provision framework and is thus liable to some sort of reporting. This is usually to a higher authority and may in extreme cases prompt legal action as suggested by Mathews et al, (2016, Pg. 52)

Reference List

Bismark, M. M., Spittal, M. J., Morris, J. M., & Studdert, D. M. (2016). Reporting of health practitioners by their treating practitioner under Australia’s national mandatory reporting law. The Medical journal of Australia, 204(1), 24.

Brashler, R., Finestone, H. M., Nevison, C., Marshall, S. C., Deng, G., Bismark, M., & Mukherjee, D. (2016). Time to make a call? The ethics of mandatory reporting. PM&R, 8(1), 69-74.

Bravo, K., Cochran, G., & Barrett, R. (2016). Nursing Strategies to Increase Medication Safety in Inpatient Settings. Journal of nursing care quality, 31(4), 335-341.

Farre, A., Shaw, K., Heath, G., & Cummins, C. (2017). On doing ‘risk work’in the context of successful outcomes: exploring how medication safety is brought into action through health professionals’ everyday working practices. Health, Risk & Society, 19(3-4), 209-225.

Fossum, M., Hughes, L., Manias, E., Bennett, P., Dunning, T., Hutchinson, A., … & Bucknall, T. (2016). Comparison of medication policies to guide nursing practice across seven Victorian health services. Australian Health Review, 40(5), 526-532.

Giles, D., & Bills, A. (2017). Designing and using an organisational culture inquiry tool to glimpse the relational nature of leadership and organisational culture within a South Australian primary school. School Leadership & Management, 37(1-2), 120-140.

Gillespie, A., & Reader, T. W. (2017). Investigating organisational culture from the ‘outside’, and implications for investing. Psychology at LSE.

Greenfield, D., Hinchcliff, R., Hogden, A., Mumford, V., Debono, D., Pawsey, M., … & Braithwaite, J. (2016). A hybrid health service accreditation program model incorporating mandated standards and continuous improvement: interview study of multiple stakeholders in Australian health care. The International journal of health planning and management, 31(3).

Laforet, S. (2017). Effects of organisational culture on brand portfolio performance. Journal of Marketing Communications, 23(1), 92-110.

Mathews, B., Lee, X. J., & Norman, R. E. (2016). Impact of a new mandatory reporting law on reporting and identification of child sexual abuse: a seven year time trend analysis. Child abuse & neglect, 56, 62-79.

McSherry, R., & Pearce, P. (2017). Measuring healthcare workers perceptions of what constitutes a compassionate organisational culture and working environment: Findings from a quantitative feasibility survey. Journal of Nursing Management.

Novak, J., Brunetto, Y., Shacklock, K., Farr-Wharton, B., & Brown, K. (2017). Do effective workplace relationships with management and an effective maintenance culture affect organisational safety outcomes?. Reliability Engineering and System Safety Journal.

Rajasekaran, S. K., Schnipper, J., Kripalani, S., Ramanan, R., Maxwell, S., Karpa, K., … & Englander, R. (2017). Medication Safety Curricula in US Medical Schools—A Call for Action. Medical Science Educator, 1-5.

Wahr, J. A., Abernathy III, J. H., Lazarra, E. H., Keebler, J. R., Wall, M. H., Lynch, I., … & Cooper, R. L. (2016). Medication safety in the operating room: literature and expert-based recommendations. BJA: British Journal of Anaesthesia, 118(1), 32-43.